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PCP issues - No relief- Need advice PLEASE :)

C5-6 herniation without surgeryACDF C6-7 5/12/15 (classified now as a non-union)

Has anyone else experienced a non-union of their fusion? I have ZERO bone growth at 3 months post-op. Still having a lot of pain, but not the same pain as before my surgery. Now it feels more like bone pain. I'm assuming from where the hardware is. I'm in a soft collar to stabilize, but the pain continues. My PCP seems to think I am fabricating the pain for the medication, but that couldn't be farther from the truth. It's really frustrating to be in pain every day and people seem to discredit you. My surgeon understands my pain, but my PCP called his office and told them not to prescribe medications to me that they would be taking care of it. I don't deserve to be treated like this. Any one have any advice? Anyone with the same experience?

Needed to add I am not allowed to take ANY anti-inflammatories at all, because it inhibits bone growth. Since I haven't begun to fuse at all, this is out of the question. No range of motion, manipulations or exercises via PT, so that's out as well. (All per NS) I'm so limited as to what I can do and take for pain control.

I take Celexa 40mg X1 (because my PCP believes my frustration with my pain is depression) Neurontin 100mg x3 a day, Skelaxin 800mg x3 a day, Norco 7.5/325 1x a day, if that, which does not decrease the pain (and I have to basically beg for those). Not sure where to go from here.

Comments

can take up to a year before it is fully healed. Nerve pain can be managed with the correct dosing of nerve pain medications. Gabapentin is one medication commonly used to treat nerve pain but the dosing needs to adjusted up until you get a good amount of relief from the pain, and minimal side effects. 200 mg is a very low dose of gabapentin.Three months out from fusion surgery is not all that long not to see bone growth. You don't smoke, right? If you do, you need to stop immediately since that prohibits bone growth.Nerve pain commonly flares post op and can last for several weeks or even months if the nerves were compressed prior to surgery, and then the additional irritation of the nerves of the surgery can make it harder to deal with. The good news is that it often disappears as quickly and suddenly as it appeared.Opiates typically do not help with nerve pain.The recovery from fusion surgery can take some time, up to a year or more before you are completely recovered.

Sorry! I may not have been clear enough in the first post. Yes, c5/6 is still herniated, but wasn't as bad as c6/7, so my surgeon opted to do one level first and see if that took care of the pain. Reasoning behind that, my disc was pressing on my spinal cord and I had mod-severe stenosis. So I had an anterior discectomy and fusion May 12, 2015. My PCP did initially offer PM recently (maybe a month ago), then decided against it because with my non-union, my surgeon doesn't want any other treatments right now that may or may not further my complication , so he says "they will just give you more pills and you don't need that". I am a Physical Therapist so I know what can happen with long term narcotic abuse in injury/surgery situations (in SOME patients), but most definitely, not everyone is abusing the system. I have no other relationship with this doctor other than I needed a referral to my surgeon (this all started in January)

No, I don't smoke, thank goodness! My pain is not a nerve type of pain. It's as if I can feel the screws moving as I move my neck. The vertebrae essentially are still free moving being that it isn't fused and the plate is trying to hold them in place. My pain is very localized. It's literally RIGHT where my fusion is. It's horrible. I can't even really tell a difference with the Neurontin 300mg, but if I tell him these things, he gets snappy and tells me I'm needing too much medication.

I saw my PCP today. Finally got him to look at my X-rays with me and I think he's starting to understand what's going on a little more. However, he gives me 20 pills (Norco 7.5) to last a month. After I told him that 1-1.5 pills a day didn't help. He says just try Tylenol. I would KILL my liver trying to ease this pain. I may have to ask for a PM referral next time.

Looks like a referral to PM would benefit you right now. PCP's are just getting gun shy about prescribing narcotics. I know when I first went to my PM I was scared to death because I had been with my MD for 12 years or so and when he retired it was obvious that non of the other docs in the practice were going to be willing to prescribe me what he did. Two of them thought I was on way too many meds(I was on two). The PM doc actually put me on a much better combo and upped the dosages as well. I haven't had an ER visit in over a year now. 20 Norco aren't going to do a whole heck of a lot. The PM probably would put you on long acting med with something like Norco for bt. I really think if you can it would be well worth a try. I know how awful it feels to be in pain and feel like nobody will address it properly. Keeping you in my prayers.

Let me get this straight you still have a herniation at C5/C6, it was only C6/C7 that was corrected and your surgery for that level was done three months ago? Ask your neurosurgeon for a referral to a pain management clinic and go under their care for pain control. Your PMP will still be your primary physician they just will no longer have a say in your pain control.

This is exactly the situation that I've referred to in conversation with others and it is a problem in our society and within the medical community today. You are legitimately in need of controlled pain medicines but this physician has obviously been taught to use them sparingly and the really bad part is that he or she is not letting you know that there is another option. That option is to send you to a doctor that specializes in pain control.

If you are sure that you are in the right then drop your primary care physician.

I think there's a clear difference between nerve pain such as that caused by fibromyalgia and nerve pain that's caused by an anatomical injury such as a herniation or non-fusion. I would not let anyone discourage you from seeking relief as long as you are in pain. In my experience and that of many others you can manage your pain with dosage adjustments in controlled pain medicines and around the clock treatment with an ER medicine the same as you would do with gabapentin only better. I personally do not use any of the nerve medicines, opioids only. That being said it's not a decision to be taken lightly.

Regardless of what you choose to do the healing of your body is far more important than any medicine don't lose sight of that.

When your body is so busy dealing with pain, I think it slows down healing or even prevents healing. When I had cervical fusion surgery, I was told to walk and walk and do more walking, which helps circulate blood and promote healing. When a person has severe pain, they don't feel like walking or doing anything else, and that may explain the non-fusion. I have also found that you can't get pain under control when under-medicated, and that pain pills such as hydrocodone work best only after you have gotten pain levels down to a controllable amount, often by first using stronger drugs (especially post-op), and later followed by regular dosing with hydrocodone; otherwise, hydrocodone may hardly work at all. Certainly 7.5 mg per day or less is not enough if you have ongoing severe pain.

I find it weird that a doctor would do surgery as though to determine the origin of pain. It's more normal to send you to a pain doctor to help determine, via nerve blocs or something, where the pain is coming from, unless it was easy to tell with an MRI. Also it's unusual to need to wear a collar this long after surgery, and even to need strong pain meds this long, unless you have other problems. If yours is truly a failed fusion surgery, and your surgeon does not want to address it in any way, maybe you need a second opinion from a different surgeon. Definitely I think you need a more considerate PCP and referral to a pain management doctor. It's harder than it should be, to get appropriate pain medication these days because the DEA harasses doctors who prescribe them. I have more spine problems than can be listed here, and face that problem every day.

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